Sir, readers of the BDJ may wish to have a more comprehensive view of the evidence on the possibility of links between sugar consumption and diseases other than dental caries than that offered by Gill and Gill.1

Comprehensive reviews on diet (including specific consideration of sugars) and obesity, diabetes, cancer and a range of other diseases have recently been conducted by expert groups for the World Health Organisation and the UN Food and Agriculture Organisation,2 The Institute of Medicine3 (as the basis for the five year review of Dietary Guidelines for Americans), and in the UK a particularly thorough review on cancer was conducted by COMA.4

None of these reviews have concluded that a credible body of evidence exists to support the suggestions put forward by Gill and Gill, still less that the strength of any evidence is sufficient to merit advice to the public in relation to cancer.4 Particular uncertainties bedevil the interpretation of evidence on cancer.4

It is difficult enough to persuade today's young people to limit the frequency of intake of sugars and other carbohydrate-based snacks in order to sustain the substantial improvements in oral health that have resulted from fluoride toothpaste. Experience suggests that they will not be much influenced by shroud waving about health issues much later in life, especially if these are not firmly based on sound evidence.

D. S. Gill and S. K. Gill respond: We agree with Dr Cottrell that there is no conclusive evidence to link carbohydrate consumption with the development of cancer. We wrote our original letter to inform readers of the BDJ that there was some evidence to suggest a possible link between carbohydrate consumption and the development of cancer. This followed an earlier letter outlining the possible link between the consumption of sugar-containing drinks and the development of obesity and diabetes in later life.5 We felt that dentists, as healthcare professionals, should be aware of such research as they are actively involved in advising patients about the harmful effects of excessive carbohydrate consumption and should therefore have knowledge of the wider developing issues surrounding sugar consumption and health. Although we do not recommend that mentioning this possible link with cancer should be a main focus of any dietary counselling episode, we feel that dentists have some responsibility in informing the public about wider health issues, and research reported on these, as long as this is kept in context.

As Dr Cottrell correctly states, it is difficult to convince people, particularly the young, to change their behaviour. We feel that if there is evidence to suggest that sugar consumption may have a negative impact on wider health, it should be highlighted as it can only provide added impetus for change.